Nina Owcharenko Schaefer
President Donald Trump recently said that his administration will “cherish and love” Medicaid. He’s right. Medicaid provides critical health care services to millions of low-income Americans.

But when such a program has nearly 80 million enrollees and costs taxpayers nearly $1 trillion, some scrutiny is warranted.

The Health and Human Services Office of the Inspector General and the Government Accountability Office have repeatedly warned that Medicaid needs greater oversight, accountability, and transparency.

Just because it serves low-income individuals doesn’t mean that it shouldn’t have proper oversight and regular review. If anything, Medicaid merits additional review to improve its integrity and ensure it serves those who need it most. Medicaid advocates should applaud efforts to bring greater oversight, accountability and transparency to the program.

To this end, several reforms should be considered.

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First, the federal government needs to end state financing gimmicks and loopholes.

Medicaid is a jointly financed program—both federal government and state governments share in funding it. To meet their share of the costs, states have developed clever financing arrangements to maximize the federal Medicaid contribution while minimizing state financial exposure.

For example, some states raise their share of the costs by imposing a special tax on Medicaid providers. The state then pays back those providers through reimbursements via Medicaid.

Similar tactics to manipulate federal financing arrangements also appear elsewhere in the program. These should come to an end.

Second, eligibility rules should be enforced and strengthened.

During COVID, states received additional federal funding to help offset the costs of new enrollees who lost their jobs and incomes. However, this funding was conditioned on the agreement that states wouldn’t remove enrollees even if they no longer qualified for benefits. As a result, Medicaid enrollment reached 95 million in 2023.  » Read More
https://www.heritage.org/medicaid/commentary/medicaid-deserves-be-cherished-and-loved-and-reformed